Comparing Approaches TO Therapy Part ll - Psychotherapy Explained

In 'Comparing Approaches - Part I - Counselling Explained' I explain that although counselling and psychotherapy practitioners have broadly the same therapeutic objectives, how they set out to achieve those objectives varies a lot. None of the recognised approaches to counselling and psychotherapy is 'right', 'wrong', or 'best'. All the recognised approaches work some of the time and none of them work all the time.

I have listed in Part I - Counselling Explained those areas where I feel that Counselling might be a more appropriate initial response than Psychotherapy.

The list below gives examples of areas where I feel that Psychotherapy is a more appropriate approach than Counselling.

Understanding self and others

Anger

Anxiety about forthcoming events

Changing obsessive thoughts and behaviours

Faulty and unhelpful thinking

Flashbacks & Post Traumatic Stress [PTSD]

Internal conflict

Low self esteem & self confidence

Modifying unhelpful behaviours

Overcoming addictions

Overcoming confusion

Overcoming social & general anxiety

Phobia cure

Recognising and overcoming paranoid thinking

Recurrent relationship problems

Sexual Problems

The Integrative or Multi Modal approach to Psychotherapy

What approach works best for any particular client depends on the presenting issues, the unique profile of the client, and the competency of the therapist in the particular approach/s chosen. Because no particular approach is appropriate in all circumstances many therapists [me included] practice in what is called an 'integrative' or 'multi modal' way. This means that we choose to blend therapeutic techniques according to the specific needs of the client; in other words we integrate different theories into a unified comprehensive therapeutic response to each client.

Different Approaches

The difference in approaches ranges from the empowering therapeutic relationship at the heart of Person Centred counselling [See Part I - Counselling Explained] through to the confronting of unhelpful thinking and coaching of new behaviours by Cognitive Behavioural therapists: range from the psycho analytical approach of the Psychodynamic practitioner through to the 'cure focussed' directive techniques of Transactional Analysts, Hypnotherapists and NLP practitioners. Some approaches are low in interventions e.g. Person Centred Counselling whilst others, especially Transactional Analysis [TA], Hypnotherapy, and Neuro Linguistic Programming [NLP] are high in intervention techniques.

What is an intervention?

An intervention is a piece of technique specifically focussed to change a specific aspect of the client's thinking, feeling, or behaviours. There are hundreds of proven interventions from which psychotherapists select. I am currently writing a book describing the interventions used by me with my clients during 2009/10.

The story of Alan

In Part I - Counselling Explained of this essay illustrates the diversity of client need and some of the different therapeutic responses available. Alan's story clearly demonstrates that no single theoretical approach can respond to his needs and that an integrative approach would be more beneficial. Alan's story illustrates why so many Counsellors and Psychotherapists have adopted an integrative approach and no longer rely on any one theory.

Some of the approaches to Counselling and Psychotherapy

Transactional Analysis [TA]

Psychodynamic Psychotherapy

Neuro Linguistic Programming [NLP]

Hypnotherapy

Eye Movement Desensitisation Reprocessing [EMDR]

Emotional Field Therapy [EFT]

Cognitive Behavioural Therapy [CBT]

A short description of the approaches above may be read later in this essay

Some other approaches not amplified by me in this essay:

Addiction Therapy

Anger Management

Bereavement Counselling

Couples Counselling

Family Counselling

Gestalt

Group Therapy

Humanistic [including Person Centred Counselling]

Life Coaching " Psychoanalysis

Rational Emotive Behavioural Therapy

Trauma Counselling

It's not as simple as just looking at the main approach used by the therapist

More and more therapists nowadays import techniques from approaches other than their own main approach. A survey of therapists in America a few years ago revealed over 400 combinations of approaches in use. For example, I combine techniques drawn from Transactional Analysis, Person Centred Counselling, Hypnotherapy, Neuro Linguistic Programming [NLP], Eye Movement Rapid Desensitisation [EMDR], and Cognitive Behavioural Therapy [CBT].

Some of the different approaches to Psychotherapy

The Transactional Analysis Psychotherapy [TA] Approach

TA came into prominence as a result of the work of Eric Berne on Ego States in the 1950's and 60's. TA introduced the concept that we do not communicate from one fixed mental state, rather change the way we think, feel, and behave depending on our Ego State at any moment.

Parent Ego State is the replay of archaic messages from parental figures.

Child Ego State is the replay of archaic child responses which we learned as children as a means of attempting to get our needs met.

Adult Ego State relates to the 'Here and Now' reality and is the only ego state which is not a replay from the past

We move frequently and rapidly from one Ego State to another depending on the situation we are in. Sometimes we become one of our parents. Sometimes we become ourselves as we were as a child. It all depends on the circumstances including who we are with. When we are fully present in the here and now and not replaying the past in Parent or Child ego state we are in Adult ego state. The Adult ego state is factual, reasoning, and logical. If you have watched Star Trek you may remember Spock as the character locked in Adult.

The aim of TA therapy

is to help individuals to feel, act and live appropriately to the here and now, free from restrictive and sometimes dysfunctional beliefs, feeling, and behavioural patterns established in earlier life. TA is also excellent in working with conflict and communication problems.

TA emphasises a partnership with the client in which both parties agree and clearly state the objectives and methods of the therapeutic work. The client takes personal responsibility for the aims and outcomes of change.

TA can be used in any field where there is a need for understanding individuals, relationships, communications, and systems. TA is a theory about: Psychopathology, Personality, Communication, Relationships, and Child Development. To read more about TA click here.

In NLP theory we do not experience a fixed common reality, rather a constructed subjective reality which fits our unique personal map of the world. Since we have constructed our version of reality we can reconstruct it in ways which are helpful to us.

NLP is the study of the structure of our subjective experience. NLP is about Communication, Language, Modelling Excellence, and a Theory of Internal Experience. NLP enables us to understand our own map of the world and work out others Map Of The world so we can relate to them effectively. It was developed in the 1980's by Richard Bandler and John Grinder.

Principles /Presuppositions of NLP

We are each unique and experience the world in different ways

We respond to our subjective map of reality: not reality

The map can be changed in therapy

Our senses filter experience so that it confirms and locks us in [unhelpfully] to our constructed map of reality " Mind and body are one system

We are always communicating - even when we are silent " Anything can be accomplished if the task is broken down into small enough pieces

The Eye Movement Desensitisation Reprocessing [EMDR] Approach

EMDR was the creation of Francine Shapiro in 1987. Nobody knows exactly why it works but it has been proved many times in practice. A change in feelings about a past traumatic experience is achieved by passing two fingers to and fro about 15 inches in front of the clients face. The client follows the finger movement with his eyes without moving his head and simultaneously holds in mind the situation being worked on. After a number of passes, and sets of passes, the client experiences a reduction in the anxiety provoked by memories of the past traumatic event. EMDR gained recognition largely as a result of Francine Shapiro's successful work with traumatised Vietnam war veterans.

EFT [Emotional Field therapy]

has much in common with EMDR. Designated parts of the face and body are subject to tapping whilst repeating a positive affirmation. Eye movement whilst tapping is also a feature. The theory is that the tapping of acupuncture points and energy lines is what produces the changed feeling and reduction in anxiety.The Freudian Psychodynamic Psychotherapy Approach 'Freudian therapists concentrate on helping their clients to come to an understanding of previously unconscious aspects of themselves' The rest is up to the client once they understand the problem!

In Freudian theory the id is the part of us that we were born with. It is the uncivilised, totally self interested, part of us that contains raw selfish, sexual and aggressive impulses. The ego is seen as that part of us responsible for co-ordinating internal and external reality. Its main purpose is seen as trying to satisfy the selfish drive of the id in a way that keeps us out of danger. Later, in our development the values of the ego become internalised, become 'reality', and shape the superego. This is the part of us that rewards us with good feelings when we are 'good' and reproaches us when we are 'bad'. Feelings of guilt and low self esteem are evoked when the values of the superego have been contravened, when we break our internalised 'rules'.

Freudians believe that psychological disturbance comes from conflict between the id, ego, and super ego. Psychological health is to be achieved by bringing the internal conflict between id, ego, and super ego into consciousness and learning to deal with it adaptively and creatively.

At first glance Psychodynamic theory of id, ego, and superego may seem to link with Transactional Analysis theory about the Parent, Child, and Adult ego states where inner conflict between the different ego states is also seen as the cause of disturbance. However, closer examination of the two theories [beyond the scope of this essay] reveals fundamental differences.

The Cognitive Behavioural Therapy [CBT] Approach

Cognitive Behavioural Therapy is a combination of two separate theoretical approaches.

Behaviour Therapy

The term 'Behaviour therapy' was coined originally by Skinner and made popular by Lazarus in the 1950's. However, the approach of reducing anxiety by exposing the client to a feared situation was written about by Locke as long ago as 1693. In 1800 rewards were applied by a captain in the Royal Navy to control prisoner behaviour. Freud acknowledged the importance of behaviour therapy.

Behaviourist believe that human behaviour, both normal and abnormal is determined by learning and by conditioning. Behaviour can be changed by changed conditioning. Symptoms are viewed as the product of faulty, distorted, inappropriate reasoning in response to a neutral stimulus i.e. a stimulous which would not normally result in such reasoning [such as a phobic reaction to vomit]. The foundation of the behavioural therapeutic approach is to help the client unlearn the distorted reasoning and overcome the unhelpful behaviour by exposure to the feared stimulous [as in phobia therapy]. Behaviour therapy focuses on agreeing behaviour changes with the client rather than analysing how come the client is behaving in that way.

In contrast to Psychoanalytic, Psychodynamic, Transactional Analysis, Person Centred and other approaches, Behaviour Therapy is focussed on the overt problem rather than trying to uncover the underpinning and unconscious processes leading to the problem/s. The aim is to directly work on behaviour change using homework and practice of changed behaviours. Goals are important. A family member or friend often acts as co-therapist and supporter during the exposure exercises. The major tools are behavioural analysis, exposure, step by step reduction in unhelpful behaviours, and practice of new behaviours.

Cognitive Therapy

Dissatisfaction with the explanation of learned behaviour as the sole cause of problems led Lazarus in 1971 to argue for an approach which introduced cognitive processes - addressing unhelpful ways of thinking. Cognitive approaches stress the importance of each person's perception of events rather than the reality of the event. Cognitive therapy focuses on overcoming unhelpful ways of thinking.